Graves Disease

Question 1

What is Graves Disease?

Answer 1

Presence of TSH-receptor stimulating antibodies that lead to hyperthyroidism due to loss of negative feedback.

Question 2

List 7 risk factors/ triggers for Graves disease

Answer 2

FH
Female
Smoking
High iodine intake.
Postpartum
Stress: Trauma/ surgery to the thyroid, psychological 
Biological agents/ Cytokine therapy

Question 3

Give 2 facts about the epidemiology of Graves disease

Answer 3

Hyperthyroidism is COMMON + Graves’ is the most common cause

Rarely occurs in children

Question 4

List 8 symptoms of Graves disease

Answer 4

Weight loss despite increased appetite.
Irritability.
Weakness + fatigue.
Diarrhoea ± steatorrhoea.
Mental illness (anxiety to psychosis)
Heat intolerance.
Loss of libido.
Oligomenorrhoea/ amenorrhoea.

Question 5

List 12 signs of Graves disease

Answer 5

Lid lag  
Exopthalmus
Goitre  
Hair thinning  
Palmar erythema  
Sweaty + warm palms  
Fine tremor  
Tachycardia (may be AF) 
Gynaecomastia 
Urticaria/pruritus 
Brisk reflexes  
Proximal myopathy

Question 6

List 4 appropriate investigations for Graves disease

Answer 6

TFTs
Autoantibodies
Imaging
Inflammatory Markers: CRP/ESR raised in subacute thyroiditis

Question 7

What would TFTs show in Graves?

Answer 7

low TSH + high T3/T4

Question 8

What 3 autoantibodies may show in Graves?

Answer 8

Stimulating TSH-receptor antibodies: very sensitive + specific for Graves
Anti-TPO antibodies (thyroid peroxidase) in 75% of Graves
Anti-thyroglobulin antibodies

Question 9

What imaging would be used to investigate potential Graves?

Answer 9

Thyroid ultrasound

Thyroid uptake scan: hot overactivity

Question 10

How is hyperthyroidism treated?

Answer 10

Carbimazole 20-40mg OD (takes time to work)

Propranolol 20mg TD